Ahmet Ural

Prevalence of allergic rhinitis among the adult population in Turkey

Conclusion: The prevalence of self-reported and physician-diagnosed allergic rhinitis (AR) exhibits significant variability across the seven geographical regions in Turkey. Our findings may contribute to the formulation of public health policy and development of preventive and therapeutic strategies for AR in Turkey. Objective: The purpose of this study was to assess the prevalence of AR in the Turkish adult population, with emphasis on descriptive parameters in seven distinct geographical regions in Turkey. Methods: The volunteers were evaluated with a custom-designed questionnaire for AR. Sample size for the study was calculated by allowing for 2% error in prevalence along with a 95% confidence interval (CI). At the end of the study, we reached 4125 volunteers. The data were analyzed with χ2, ANOVA, and Tukey (post hoc) tests. Results: A total of 4125 volunteers participated in the study; 2200 were female and 1925 were male. On the basis of self-reporting, 23.1% of the study population was considered to have AR (males 22.3%, females 23.8%). On the other hand, the prevalence of physician-diagnosed AR was 20.1% (males 19.7%, females 20.4%). The prevalence of self-reported AR was 23.8% in the urban and 18.4% in the rural areas.

Role of Leukotriene Antagonists and Antihistamines in the Treatment of Allergic Rhinitis

Allergic rhinitis is the most common atopic disorder seen in ENT clinics. It is diagnosed by history, physical exam and objective testing. Patient education, environmental control measures, pharmacotherapy, and allergen-specific immunotherapy are the cornerstones of allergic rhinitis treatment and can significantly reduce the burden of disease. Current treatment guidelines include antihistamines, intranasal corticosteroids, oral and intranasal decongestants, intranasal anticholinergics, intranasal cromolyn, and leukotriene receptor antagonists. In the mechanism of allergic rhinitis, histamine is responsible for major allergic rhinitis symptoms such as rhinorrhea, nasal itching and sneezing. Its effect on nasal congestion is less evident. In contrast, leukotrienes result in increase in nasal airway resistance and vascular permeability. Antihistamines and leukotriene receptor antagonists are commonly used in the treatment of allergic rhinitis. The published literature about combined antihistamines and leukotriene antagonists in mono- or combination therapy is reviewed and presented.

Surgical Outcomes for Rhinogenic Contact Point Headaches

Objective: To evaluate the surgical outcome in patients diagnosed as having rhinogenic contact point headaches (RCPH). Subjects and Methods: Thirty-six patients (aged 17–58 years) with RCPH underwent mini functional endoscopic sinus surgery procedures. Patients’ pain complaints were evaluated with a visual analog scale (VAS) both pre- and postoperatively. Results: All patients reported a decrease in the intensity of pain postoperatively. Nineteen patients (52.7%) reported complete relief. The difference between the preoperative (mean 8.62) and postoperative VAS pain scores (mean 2.11) was statistically very significant (p = 0.0000). No major complications were encountered. Conclusion: The removal of contact points in patients with RCPH is very effective in carefully selected patients.

Nasal polyposis: an overview of differential diagnosis and treatment.

Nasal polyposis is a chronic inflammatory disease of the nasal and paranasal sinus mucosa. Etiology remains unclear, but allergy, asthma, aspirin sensitivity, cystic fibrosis, and infection have been associated with the disease. Clinically, nasal obstruction, anosmia/hyposmia, rhinorrhea, postnasal drainage, headaches, facial pain, and sleep disorders constitute the main symptoms. Intranasal examination reveals bilateral, mobile, grey, smooth and semi translucent polypoid masses that usually originate in the ethmoid sinuses or the middle meatus. Differential diagnosis is important to rule out congenital anomalies, as well as benign or malignant tumors. In the evaluation of nasal polyps, computerized tomography is helpful especially in determining the extent of the disease and in planning the surgical approach. Management of nasal polyposis consists of medical therapy and surgery. Surgical treatment is performed in cases that are refractory to medical therapy. Recurrence of nasal polyps is quite common and medical therapy after surgery is often necessary for avoiding recurrences. This paper aims to summarize the current trends in the diagnosis, management of nasal polyposis and relevant patents.

The Score For Allergic Rhinitis study in Turkey.

Background The clinical definition of allergic rhinitis (AR) is difficult to use in epidemiological settings of large populations where it is impossible to obtain the laboratory evidence of each immune response. However, the standardization of the definition of AR in epidemiological studies is of crucial importance. This study was designed to estimate the prevalence of AR in an adult general population with respect to seven distinct geographical regions in Turkey. Methods Individuals were evaluated with the Score for Allergic Rhinitis (SFAR) questionnaire for a national cross-sectional study. The Turkish version of the SFAR questionnaire was tested for clarity and sensitivity in a small sample of the general population. Results Among the 3967 interviewed subjects, the overall prevalence of AR was 29.6%, with regional variations (from 21.0% in the southeastern Anatolia region to 36.1% in the Marmara region). The prevalence was higher in women and in urban area of residence. Conclusion This national survey confirmed the elevated prevalence of AR in Turkey. Our findings may contribute to the formulation of the public health policy and development of preventive and therapeutic strategies for AR in eastern Europe.

The histopathological effect of thymoquinone on experimentally induced rhinosinusitis in rats.

Background Rhinosinusitis is a common disorder and its treatment includes a variety of topical and systemic drugs. This study was designed to determine the histopathological effect of thymoquinone on experimentally induced rhinosinusitis in rats. Methods Sixty rats were randomly allocated into 3 test and 2 control groups, each of which consisted of 12 animals. The rhinosinusitis model was induced using intranasal application of platelet-activating factor. In test groups, the animals were separated into groups: (1) rhinosinusitis-antibiotherapy, (2) rhinosinusitis-thymoquinone, (3) rhinosinusitis-combination therapy. The positive and negative control groups were defined: rhinosinusitis group without any treatment and the group without rhinosinusitis, respectively. The histopathological features (vascular congestion, inflammation, and epithelial injury) in nasal respiratory and olfactory mucosa of animals were examined and graded according to their severity. A quantitative and statistical analysis of histopathological features was performed. Results All histopathological features showed statistically significant differences between negative and positive control groups, respectively. Conversely, neither the group with rhinosinusitis-antibiotherapy nor the group with rhinosinusitis-thymoquinone had a statistically significant difference with the negative control group. Moreover, none of the histopathological features showed a statistically significant difference, when the group with rhinosinusitis-antibiotherapy and the group with rhinosinusitis-thymoquinone were compared. A statistically significant difference was not determined when the group with rhinosinusitis-combination therapy was compared with the group with rhinosinusitis-thymoquinone. The histopathological features did not show a statistically significant difference between the group with combination therapy and the negative control Conclusion Thymoquinone is a promising bioactive agent for the treatment of rhinosinusitis, and its histopathological effect is as equivalent as an antibiotic.

Desloratadine‐montelukast combination improves quality of life and decreases nasal obstruction in patients with perennial allergic rhinitis

The effects of desloratadine‐montelukast combination on quality of life (QoL) and nasal airflow of patients with perennial allergic rhinitis (PAR) has not been reported. The objective of this work was investigate the efficacy of desloratadine‐montelukast combination on nasal obstruction and health‐related quality of life (HRQL) of patients with PAR.

Association of inferior turbinate enlargement, concha bullosa and nasal valve collapse with the convexity of septal deviation

Abstract Conclusion: Inferior turbinate enlargement (ITE), nasal valve collapse (NVC) and concha bullosa (CB) are nasal anatomic problems that may accompany septal deviation (SD). Establishment of a causal relationship between these variations and SD is doubtful. In patients complaining of nasal obstruction, all nasal structures that may contribute to the symptom must be separately and carefully assessed for setting an appropriate treatment plan and thereby minimizing the failure rate of surgery. Objective: To investigate if the convexity of SD is associated with the occurences of ITE, CB and NVC. Patients and methods: This retrospective study was performed on 109 patients who had been operated due to anterior C-shaped SDs. ITE, CB and NVC were encountered in 65 (59.6%), 27 (24.8%) and 55 (50.5%) patients, respectively. Patients with other forms of SD, allergic rhinitis, non-allergic rhinitis with eosinophilia, acute and chronic sinusitis, nasal polyposis, antrochoanal polyps, those who had recently used systemic or topical decongestants and patients with a history of previous nasal surgery were excluded from the study group. Assessment of the patients was based on data derived from the history, physical examination findings and paranasal sinus CT imaging records. Results: No significant correlation was found between the convexity of the SD and occurrence of ITE, CB and NVC (p = 0.098, 0.717 and 0.171, respectively).

Giant sialolith of submandibular gland: report of a case

Sialolithiasis is one of the most common diseases of salivary glands in middle-aged patients. Sialoliths are localized in submandibular glands in nearly 80% of the reported cases and they are classified as ‘giant’ in case any dimension exceeds 15 mm. Giant sialolith in submandibular gland is a rare disorder. Here, an unusual case of giant sialolith in submandibular gland is reported. A 42-year-old man referred with complaints of recurrent pain and swelling in the left submandibular area. Computerized tomography revealed a calcified mass of 42 × 17 mm size within the submandibular gland. Excision was performed in the submandibular gland and a giant sialolith of 35 mm length localized in the body of the gland was detected. The postoperative period was uneventful and the patient fully recovered.

The Score for Allergic Rhinitis (SFAR) Study in Turkey

were present with a large septal spur and no recognizable sinonasal landmarks. The mean distance from the posterior edge of the maxillary natural ostium to the anterior edge of the sphenopalatine foramen was 23.79 mm (95% CI 22.03-25.55). CONCLUSION: The method of performing SPA ligation via lateral nasal wall incision without uncinectomy or maxillary antrostomy was successful in 90% of human cadaveric heads. In all specimens in which the lateral nasal wall incision was unsuccessful in locating the SPA, maxillary antrostomy was successful. No specimen required uncinectomy. The mean distance from maxillary natural ostium to SPA foramen was over 2cm. The routine use of maxillary antrostomy and uncinectomy is not needed to locate the SPA foramen in most nasal cavities, and moreover produces unnecessary mucosal trauma in the often medically fragile or coagulopathic patient.